Internal fixation of lateral and medial borders for displaced scapular body fractures via minimally invasive approach:results of 23 cases / 浙江大学学报·医学版

OBJECTIVE: To evaluate the efficacy of internal fixation of lateral and medial borders for displaced scapular body fractures via the minimally invasive approach. METHODS: The internal fixation of lateral and medial borders via minimally invasive approach was applied in surgical treatment of 23 patients with scapular body comminuted fractures from January 2014 to June 2018. The lateral approach was made straightly orienting over the lateral border of scapula. The dissection was taken down to the deltoid fascia. The deltoid was retracted cephalically, revealing the external rotators. Blunt dissection was used down to the lateral border between infraspinatus and teres minor, exposing the fracture site. The medial incision was done along the medial border of the scapula over site of the fracture. Dissections were taken down to the fascia and the periosteum. A subperiosteal dissection was then performed to elevate the infraspinatus to the degree necessary to visualize the fracture. The medial and lateral borders of scapula body were fixed with plates and screws in a frame-like way. RESULTS One patient developed the delayed healing of the incisions due to liquefactive fat necrosis. The other 22 patients showed no complications of the incisions. The glenopolar angle (GPA) of fractured scapula was increased from preoperative (25±12) degrees to postoperative (41±5) degrees (P<0.01). The healing time of fractures healed was 3-8 months, with an average time of (4.4±1.3) months. CONCLUSIONS The lateral-medial combined fixation through minimally invasive surgical approach for the scapula body fractures allows visualization of fracture reduction without extensive muscular or subcutaneous flaps, and is associated with successful fracture healing and high functional scores of the shoulder.

Total hip arthroplasty for postoperative ankylosis in patients with hip peripheral fracture / 中华创伤杂志

Objective To discussion the feasibility and effect of total hip arthroplasty (THA) of postoperative ankylosis in patients with hip peripheral fracture.Methods From January 2008 to October2013,cementless THA was performed in 23 patients with ankylosis after internal fixation of hip peripheral fracture.There were 16 males and 7 females,aged 23 to 67 years (mean,43 years).Interval between internal fixation and THA was 12 to 73 months (mean,38 months).Results Mean follow-up was 28 months (range,3 to 60 months).All patients presented good press-fit prostheses with mean acetabular valgus of 43.3°,mean acetabular anteversion of 22.5°,and mean femoral anteversion of 16.4°.Primary wound healing was detected with no occurrence of infection,prosthetic loosening or dislocation,and periprosthetic fracture.Femoral vein incomplete embolism was diagnosed in one patient with limb swelling 2 months after operation,but swelling subsided after 3 months of bed rest,elevation of the affected limb and anticoagulant therapy.Length of the bilateral limbs was almost equal in 19 patients with the difference within 0.5 cm,but the affected limb was 0.8-1.4 cm shorter in 3 patients and was 0.8 cm longer in 1 patient.Harris hip score improved from (42.16 ± 3.03)points before operation to (93.08 ± 5.23) points at the last follow-up (P ＜ 0.05).Conclusion THA is associated with good hip function recovery and improved quality of life during the treatment of postoperative ankylosis in patients with hip peripheral fracture.

The radiographic classification and presentations of atypical spinal tuberculosis / 中华骨科杂志

Objective To investigate the radiographic classification and presentation of atypical spinal tuberculosis in adults.Methods Data of 45 consecutive patients who had suffered from atypical spinal tuberculosis confirmed by surgical interventions and pathologic examinations at our department from February 2000 to August 2012 were retrospectively analyzed.There were 29 males and 16 females,aged from 20 to 71 years (mean,46.2 years).Twenty-five patients presented with low-grade fever,lassitude and loss of weight,and the other 20 patients denied the constitutional symptoms of tuberculosis.An increased erythrocyte sedimentation rate (range,25-107 mm/1 h) was found in 37 patients.All patients were investigated by the following imaging resources:plain X-rays,CT scan and MRI.3D reconstruction CT was performed in 12 patients and PET-CT was performed in 2 patients.All patients were treated surgically and confirmed by pathologic examinations and 3 patients had undergone CT-guided biopsy.Results Atypical spinal tuberculosis presented in different radiographic presentation forms.Nine patients had involvement of a single vertebral body,which was depicted with nonuniformly increased signal intensity on T2-weighted MR images.CT scan showed irregular bony destruction in old patients and solitary osteolytic lesion with well-defined margins in young adults.There were 2 cases of isolated affection in the posterior elements (vertebral appendages type),and the involved vertebral appendages demonstrated hyperintense signal on T2-weighted MR images and bony destruction on CT scan.There were 8 cases of simultaneous affection in the anterior and posterior element of one vertebra (circumferential vertebral involvement type),and CT scan showed multiple bony destruction in vertebral body and neural arch.There were 5 cases of affection in disc (intervertebral disc involvement type),which presented decreased signal in MRI and protruding disc pressing the dural sac could be found.There were 14 cases of multiple vertebral tuberculosis in continuity (contiguous spinal tuberculosis),which presented multiple tuberculosis lesions on 3D-CT.There were 7 cases of multiple vertebral tuberculosis in noncontinuity (noncontiguous spinal tuberculosis),which presented destructive tubercular lesions affected different levels in different regions of the spine on MRI.Conclusion Atypical spinal tuberculosis had multiply radiographic presentation forms and atypical radiographic features.Worm-eaten destruction of bone or vertebral endplate,marrow edema and increased signal intensity of paraspinal ligament are features of radiographic presentation in diagnosis of atypical spinal tuberculosis.

Hip replacement for bony ankylosis of the hip following ankylosing spondylitis / 中华创伤杂志

Objective To investigate the clinical significance and effect of total hip arthroplasty (THA) in treatment of bony ankylosis of the hip in patients with ankylosing spondylitis (AS).Methods The study enrolled 23 patients (35 hips) undergone THA for bony ankylosis of the hip in AS between March 2008 and November 2012.Postoperative outcome was measured based on Harris hip score and Xray images.Results Preoperative Harris hip score of (27.6 ± 2.3) points increased to (86.7 ± 2.6)points postoperatively.Hip flexion and adduction deformity presented correction postoperatively.Total hip range of motion (flexion,adduction,abduction,and external rotation) improved from (45.7 ±5.3) o preoperatively to (206.9-±4.7) °postoperatively and mean hip flexion activity was 81 °.Hip activity achieved significant improvement and pain was relieved.X-ray films revealed proper position of prostheses without the presence of loosening or subsidence.Two patients (3 hips) experienced mild pain after a long period of walking.Four patients had heterotypic ossification including Brooker grade Ⅱ in one patient and Brooker grade Ⅰ in three.Conclusion THA is an effective treatment for bony ankylosis of the hip in AS,for it rebuilds joint function,relieves pain of the hip and improves patients' quality of life.

One-stage corpectomy for the serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits / 中国矫形外科杂志

[Objective] To study the mechanism and clinic characteristic to the serious spinal cord compression from vertebral tuberculosis in the absence of nenrologic deficits.[Method]A total of 15 patients with serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits were treated by one-stage debridement,lilac grafting and internal fixation.The clinical characters were retrospectively analyzed.[Result]All these patients had no sinus formation and no recurrence of spinal tuberculosis during average the follow-up of 3.8 years(range:6 months to 7 years).In 5 cases with incomplete paraplegia,3 cases improved 2 grades,1 case was no change and 1 case became serious.[Conclusion]The serious spinal cord compression from vertebral tuberculosis in the absence of neurologic deficits has a long history in illness,the spinal cord is in crisis condition even it can get adjustment by itself.The early one-stage treatment of debridement,iliac grafting and internal fixation can guarantee the restore the spinal cord and spine stability.

Correlative Investigation of Lumbar Lordosis in Chronic Low Back Pain Patients / 实用放射学杂志

Objective To investigate the correlation between the prevalence of chronic low back pain(CLBP)in cold plateau region in young men and the lumbar lordosis angle (LLA) on X-ray plain film.Methods Questionnaire, clinical findings, physical status and LLA measurement were obtained in 163 cases of different occupational young men.The relation between CLBP,body mass index(BMI) and LLA were studied.There were 77 cases of tankmen,54 cases of artillerists,32 cases of local resident(age 17~28 years). Results In 163 young men ,there were 63 cases with CLBP ( 38.8% ) . CLBP in tankmen was more frequency ( 47.0% ) than that in artillerists and local resident (P